House Republicans have introduced an Obamacare replacement plan after years of promising they would come up with one.
But while it's backed by House Speaker Paul Ryan and leaders on the major committees with jurisdiction, the plan leaves out a number of key details and doesn't say how much it would cost or save. Ryan, who will discuss the plan at the American Enterprise Institute Wednesday, has stressed that it's merely a blueprint to show Americans how Republicans would reform healthcare should they get a chance next year.
"It is laying the groundwork for what the Congress would do next year to put legislative specifics behind," a senior GOP House leadership aide told reporters Tuesday.
The proposal, dubbed "A Better Way Health Care Plan," contains many elements common to other GOP plans. For those without employer-sponsored coverage, it would provide people with age-based, refundable tax credits to buy coverage, instead of the income-based subsidies under President Obama's healthcare law.
The plan would allow insurance to be sold across state lines, provide $25 billion for states to set up high-risk pools for those with steep medical bills, financially reward states for finding innovative ways to reduce premiums and the uninsured rate, and enact medical liability reforms.
Republicans did seek to achieve some of the same goals of the Affordable Care Act, but in different ways. Their plan would repeal the individual mandate to have coverage but try to incentivize people to sign up by stipulating that insurers can't charge them more for pre-existing conditions if they enroll during a one-time enrollment period.
The GOP plan also would maintain the current system of employer-sponsored coverage, which provides most people with insurance. But to discourage employers from offering massively expensive plans, it would replace the Affordable Care Act's "Cadillac tax" with a cap on the employer tax exclusion.
In a nod to the millions of Americans newly ensured through the healthcare law, the plan doesn't entirely wipe out the law's spending or consumer protections. Starting in 2019, Medicaid spending would start shifting to a per capita system drawn from a fixed federal spending allotment. States that had expanded Medicaid under Obamacare would receive the same funding for higher-income beneficiaries, but they would be allowed to shift those dollars to lower-income enrollees.
The plan doesn't signify consensus for Republicans, who have consistantly struggled to agree on how to reform the expensive U.S. healthcare system and help uninsured Americans get coverage. And it's not clear exactly what policy changes presumptive GOP presidential nominee Donald Trump would support if he took the White House next year.
But for Ryan, it's a step he has wanted to take for years. During a 2012 interview with the Washington Examiner, Ryan said he wanted to put out a "vision" for replacing the Affordable Care Act that a Republican nominee — then Mitt Romney — could act on as president.
"I think what we will aspire to do is put out a vision on what a patient-centered healthcare system looks like," Ryan said at the time. "And that vision is the replace side of repeal, which is what we want to execute in 2013."
That possibility didn't come about, as Obama won his second term and Republicans faced four more years of fruitless attempts to ditch his health law. Success is no more assured next year, as presumptive Democratic presidential nominee Hillary Clinton is besting Trump in polls.
Yet Ryan has insisted that under his leadership, House Republicans will show they have policy teeth by releasing a series of white papers outling reforms in not just healthcare but also poverty, taxes and national security. And keeping it free of cumbersome spending figures or estimates of the uninsured helps shield Republicans somewhat from Democratic attacks.
"We're confident this proposal, if taken together, actually reduces the deficit," the GOP House aide said.